IntroductionThe use of topical mitomycin C (MMC) has gained popularity in the management of ocular surface neoplasia. The aim of this study is to determine outcomes and complications following such treatment. Methods This study is a retrospective review of patients treated with topical MMC for ocular surface neoplasia, including primary acquired melanosis (PAM), melanoma, cornealeconjunctival intraepithelial neoplasia (CCIN), squamous cell carcinoma (SCC) and sebaceous gland carcinoma (SGC). Data regarding diagnosis, short-and long-term outcomes, and short-and long-term complications, were recorded. Results 58 patients were identified, with a mean age of 63 years and mean follow-up of 36 months. 21 received MMC as primary therapy and 37 as surgical adjuvant. The regimen was 0.04% MMC four times a day for 3 weeks on, 3 weeks off, 3 weeks on, with topical steroid and lubricants throughout. Initial clinical response was either partial or complete in 93%. Overall, 26% developed recurrent disease at a mean of 13 months post treatment. Recurrence rates by pathology were 20% PAM, 25% melanoma, 0% CCIN, 67% SCC and 57% SGC. Short-term complications occurred in 52%, but only 7% required treatment cessation. Long-term complications such as persisting keratoconjunctivitis, epiphora and corneal problems, occurred in 31%. Conclusion The results confirm the effectiveness of topical MMC chemotherapy in the management of ocular surface neoplasia. Self-limiting short-term complications were common; however, limbal stem cell deficiency appears to be a significant long-term complication of treatment, occurring in 12%.
Purpose To review the clinicopathological features, management, and survival rates for patients with sebaceous gland carcinoma of the eyelid, and to analyse the reasons for improved survival. Methods In the west of Scotland between 1975 and 2001, 32 cases were identified through the pathology index for sebaceous carcinoma. Pathology specimens were reviewed in all cases. The clinical data were obtained from hospital records and the database provided by the Regional Cancer Registry. Results A total of 22 female and 10 male patients were identified. Follow-up ranged from 6 months to 15 years, median of 4.8 years. Primary treatment involved excisional techniques in 27 cases, exenteration in two cases, enucleation in two cases, and two cases required adjuvant radiotherapy. Intraepithelial spread and masquerade presentations delayed the diagnosis. Poorly differentiated tumours were associated with an unfavourable outcome. Three patients developed local tumour recurrence and one metastatic disease. In all, 10 patients died from nontumour-related causes and one died from metastatic sebaceous carcinoma. The overall tumour mortality rate in the west of Scotland was 3%. Conclusions From this study, patients in the west of Scotland have a better prognosis than is indicated in the literature. Astute clinical suspicion and accurate histopathological diagnosis, together with radical and aggressive surgical approaches were key factors.
Others have demonstrated a BRAF T1799A-activating mutation in cutaneous but not uveal melanoma. In this study, this BRAF mutation was demonstrated in some conjunctival melanoma tissue samples, suggesting that some conjunctival melanomas may share biological features in common with cutaneous melanoma.
ascular masses occurring in the peripheral retina have been described extensively in the literature. Many terms, including "presumed acquired hemangiomas," "hemangiomalike," "angiomatous masses," "angioma-like," "peripheral retinal telangiectasis," and "vasoproliferative tumors," have been suggested that reflect the lack of the known histological features and the potentially variable causes. We describe the histological features of 2 patients who underwent transcleral local resection as management for suspected choroidal melanoma. Pathological examination of these tumors reveals the constituents to be primarily benign glial cell proliferation with secondary vasoproliferation. The weight of the literature agrees with a reactionary process. We therefore suggest the term "reactionary retinal glioangiosis." Transcleral resection has a place where diagnosis is difficult. It prevents an unnecessary enucleation and allows accurate tissue diagnosis.
Surgical technique has been previously reviewed, and these established principles were used when attempting to correct the observed deformation of the upper lids.' Grading the entropion was conducted by detailed attention to the position of the meibomian gland orifices, conjunctivalisation of the lid margin, the position and direction of the lashes, palpable and visual assessment of the tarsal plate, and the presence or absence of keratin deposits on palpebral conjunctiva.2Correspondence to E G Kemp, FRCS, Department of Ophthalmology, Ninewells Hospital, Ninewells, Dundee DD1 9SY. Patients and methodsA total of 107 patients were reviewed and 183 surgical corrections of upper lid entropion were carried out.
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